Why the study?
The feasibility and accuracy of an integrated echocardiography and lung ultrasound approach to evaluate fluid responsiveness needed assessment in patients with acute circulatory failure.
Does an integrated ultrasonographic approach using echocardiography and lung ultrasound accurately evaluate fluid responsiveness and guide therapy in critically ill patients with acute circulatory failure?
Does an integrated ultrasonographic approach using echocardiography and lung ultrasound accurately evaluate fluid responsiveness and guide therapy in critically ill patients with acute circulatory failure?
An integrated approach using echocardiography and lung ultrasound is feasible and accurate for guiding fluid management in critically ill patients with acute circulatory failure.
May support bedside echo-lung ultrasound for fluid responsiveness assessment in acute circulatory failure; hypothesis-generating and requires prospective validation before practice change.
Purpose In patients with acute circulatory failure, we tested the feasibility and accuracy of an approach based on echocardiography and lung ultrasound to evaluate fluid responsiveness (FR). Methods We enrolled 113 consecutive patients admitted to the Emergency Department High-Dependency Unit of Careggi University-Hospital from January 2015 to June 2020. We assessed the inferior vena cava collapsibility index (IVCCI) and the variation of aortic flow (VTIAo) during the passive leg raising test (PLR). We performed a lung ultrasound to verify the presence of interstitial syndrome. FR was defined as an increase in the VTIAo > 10% during PLR or IVCCI ≥ 40%. FR patients were treated with fluid and those non-FR with diuretics or vasopressors. The therapeutic strategy was reassessed after 12 hours and the goal was to maintain the strategy based on the initial evaluation. Results among 51 FR patients, at lung ultrasound, 15 patients showed basal interstitial syndrome and 4 all-lung involvement. One fluid bolus was given to 51 patients. Among 57 non-FR patients, 26 patients showed interstitial syndrome at lung ultrasound (basal fields in 14, all lungs in 12). We administered diuretics to 21 patients and vasopressors to 4 subjects. We had to change the initial treatment plan in 5 (9%) non-FR patients and in 6 FR patients (12%, p = NS). In the first 12 hours after the evaluation, non-FR patients significantly less fluids compared to those FR (1119 ± 410 vs 2010 ± 1254 ml, p < 0.001). Conclusions the approach involving echocardiography and lung ultrasound allowed an accurate evaluation of the FR among critically ill patients.
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Innocenti et al. (2022) studied this question.
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